急性脑梗死患者早期血清生物标记物水平变化

Changes of serum biomarker levels in patients with acute cerebral infarction at early stage

目的通过检测急性脑梗死患者血清同型半胱氨酸(Hcy)、胆碱酯酶(CHE)、N末端B型钠尿肽前体(NT-proBNP)和D二聚体(D-dimmer)水平变化,探讨适用于基层医院的急性脑梗死患者早期诊断指标。方法以2013年1月至2017年12月神经内科收治的所有第一次因急性期脑梗死住院的患者206例,其中中小面积脑梗死患者126例,大面积脑梗死患者80例,同期于体检科体检的健康体检者者中随机选择120例为对照组。均于入院24h内采集静脉血,应用NIHSS评分,以同期健康体检者为对照组检测血清Hcy、CHE、NT-proBNP和D-dimmer水平,比较各因素的变化情况;预后良好的单因素与多因素分析;受试者工作特征曲线分析各指标对ACI的诊断价值。结果ACI组患者血清Hcy、NT-proBNP和D-dimmer水平显著高于对照组,大面积脑梗死患者的血清Hcy、NT-proBNP和Ddimmer水平显著高于中小面积脑梗死组(P<0.05);与对照组比较,而大面积脑梗死组患者血清CHE水平显著下降(P<0.05),中小面积脑梗死患者的血清CHE水平明显升高(P<0.05)。单因素分析提示口服血糖(FPG)Hcy、Ddimer、BNP、CHE对ACI发病具有相关性,多因素分析提示血清BNP和CHE与预后密切相关。CHE的ROC曲线下面积为0.911,以CHE<3200U/L为临界值,其诊断敏感性为79.5%,特异性为91.0%;BNP对大面积脑梗死诊断的ROC曲线下面积为0.929,以BNP>1500ng/L为临界值,其诊断敏感性为82.3%,特异性分别为95.0%。结论血清Hcy、CHE、BNP和D-dimer水平均与ACI发病密切相关,血清BNP是ACI患者预后良好的危险因素,而血清CHE是预后良好的保护因素。二者结合,对诊断大面积脑梗死具有重要的临床价值。

Objective To investigate the changes of the serum levels of homocysteine(Hcy),cholinesterase(CHE),N-terminal pro-B-type natriuretic peptide(NT-proBNP) and D-dimer in patients with acute cerebral infarction(ACI),and to explore their diagnostic significance in early diagnosis of ACI. Methods A total of 206 patients with ACI who were admitted and treated in our hospital from January 2013 to December 2017 were enrolled in the study,including 126 cases of small area infarction and 80 cases of a large area cerebral infarction,at the same time,the other 120 healthy subjects who underwent health medical examinationin were enrolled as control group. The venous blood specimens were collected in 24 hours after hospitalization,and serum levels of Hcy,CHE,NT-proBNP and D-dimer were detected. The t-test or χ~2 test was used to compare the changes of these indexes,and the univariate and multivariate analysis and the receiver operating characteristic curve analysis were used to evaluate the clinical value of each index in diagnosis of ACI. Results The serum levels of Hcy,NT-proBNP and D-dimer in ACI group were significant higher than those in control group,moreover,which in the patients with a large area cerebral infarction were significant higher than those in the patients with small area cerebral infarction(P < 0. 05). As compared with those in control group,the serum levels of CHE were in the patients with a large area cerebral infarction were significantly decreased(P < 0. 05),however,which in the patients with small area cerebral infarction were significantly increased(P < 0. 05). The univariate analysis results showed that fasting blood sugar(FBG),Hcy,CHE,NT-proBNP,and D-dimer were related with the pathogenesis of ACI,and multivariate analysis results showed that BNPand CHE were closely correlated with the prognosis of patients with ACI. The ROC area under the cover(AUC) of serum CHE was0. 911,and serum CHE < 3,200 U/L as the critical value,the sensitivity in diagnosis of ACI was 79. 5%,specificity was 91.0%. Moreover the AUC of NT-proBNP in diagnosis of ACI was 0. 929,taking BNP > 1,500 ng/L as the critical value,the sensitivity in diagnosis of ACI was 82. 3%,specificity was 95. 0%. Conclusion The serum levels of Hcy,CHE,BNP and D-dimer are closely related with the pathogenesis of ACI,and the serum NT-proBNP is an independent risk factor for ACI,however,and the serum CHE is an independent protective factor for ACI,and the combination detection of the two indexes are important clinical significance in diagnosis of ACI.